|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$27.36
|
|
|
Service Code
|
NDC 71399445605
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$27.36 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: ASR ASR |
$26.54
|
| Rate for Payer: BCBS Complete |
$10.94
|
| Rate for Payer: BCBS Trust/PPO |
$22.56
|
| Rate for Payer: BCN Commercial |
$22.56
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$25.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.89
|
| Rate for Payer: Healthscope Commercial |
$26.54
|
| Rate for Payer: Healthscope Whirlpool |
$27.36
|
| Rate for Payer: Mclaren Commercial |
$24.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.26
|
| Rate for Payer: Nomi Health Commercial |
$22.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.97
|
| Rate for Payer: Priority Health Narrow Network |
$19.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.08
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
NDC 96295013458
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.16
|
| Rate for Payer: Healthscope Whirlpool |
$18.72
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$45.36
|
|
|
Service Code
|
NDC 41167005840
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.78 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Medicare |
$16.78
|
| Rate for Payer: ASR ASR |
$44.00
|
| Rate for Payer: BCBS Complete |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$37.40
|
| Rate for Payer: BCN Commercial |
$37.40
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$42.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$44.00
|
| Rate for Payer: Healthscope Whirlpool |
$45.36
|
| Rate for Payer: Mclaren Commercial |
$40.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Nomi Health Commercial |
$37.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.74
|
| Rate for Payer: Priority Health Narrow Network |
$31.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.92
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$30.43
|
|
|
Service Code
|
NDC 536120215
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$30.43 |
| Rate for Payer: Aetna Commercial |
$27.39
|
| Rate for Payer: Aetna Medicare |
$11.26
|
| Rate for Payer: ASR ASR |
$29.52
|
| Rate for Payer: BCBS Complete |
$12.17
|
| Rate for Payer: BCBS Trust/PPO |
$25.09
|
| Rate for Payer: BCN Commercial |
$25.09
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cofinity Commercial |
$28.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.35
|
| Rate for Payer: Healthscope Commercial |
$29.52
|
| Rate for Payer: Healthscope Whirlpool |
$30.43
|
| Rate for Payer: Mclaren Commercial |
$27.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.87
|
| Rate for Payer: Nomi Health Commercial |
$24.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26.66
|
| Rate for Payer: Priority Health Narrow Network |
$21.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.78
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$18.53
|
|
|
Service Code
|
NDC 121097005
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$18.53 |
| Rate for Payer: Aetna Commercial |
$16.68
|
| Rate for Payer: Aetna Medicare |
$6.86
|
| Rate for Payer: ASR ASR |
$17.97
|
| Rate for Payer: BCBS Complete |
$7.41
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$17.97
|
| Rate for Payer: Healthscope Whirlpool |
$18.53
|
| Rate for Payer: Mclaren Commercial |
$16.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.75
|
| Rate for Payer: Nomi Health Commercial |
$15.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.23
|
| Rate for Payer: Priority Health Narrow Network |
$12.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.30
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$30.43
|
|
|
Service Code
|
NDC 536120215
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$30.43 |
| Rate for Payer: Aetna Commercial |
$27.39
|
| Rate for Payer: ASR ASR |
$29.52
|
| Rate for Payer: BCBS Trust/PPO |
$24.99
|
| Rate for Payer: BCN Commercial |
$24.99
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cofinity Commercial |
$28.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.35
|
| Rate for Payer: Healthscope Commercial |
$29.52
|
| Rate for Payer: Healthscope Whirlpool |
$30.43
|
| Rate for Payer: Mclaren Commercial |
$27.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.87
|
| Rate for Payer: Nomi Health Commercial |
$24.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.78
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$20.87
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Medicare |
$14.09
|
| Rate for Payer: Aetna Medicare |
$7.72
|
| Rate for Payer: Aetna Medicare |
$19.61
|
| Rate for Payer: ASR ASR |
$51.41
|
| Rate for Payer: ASR ASR |
$20.24
|
| Rate for Payer: ASR ASR |
$36.95
|
| Rate for Payer: BCBS Complete |
$8.35
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Complete |
$15.24
|
| Rate for Payer: BCBS Trust/PPO |
$17.21
|
| Rate for Payer: BCBS Trust/PPO |
$31.41
|
| Rate for Payer: BCBS Trust/PPO |
$43.70
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: BCN Commercial |
$31.41
|
| Rate for Payer: BCN Commercial |
$43.70
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$35.81
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Cofinity Commercial |
$49.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.47
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Healthscope Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$36.95
|
| Rate for Payer: Healthscope Whirlpool |
$38.09
|
| Rate for Payer: Healthscope Whirlpool |
$20.87
|
| Rate for Payer: Healthscope Whirlpool |
$53.00
|
| Rate for Payer: Mclaren Commercial |
$47.70
|
| Rate for Payer: Mclaren Commercial |
$34.28
|
| Rate for Payer: Mclaren Commercial |
$18.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Nomi Health Commercial |
$43.46
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: Nomi Health Commercial |
$31.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.36
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.87
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: ASR ASR |
$51.41
|
| Rate for Payer: ASR ASR |
$20.24
|
| Rate for Payer: ASR ASR |
$36.95
|
| Rate for Payer: BCBS Trust/PPO |
$43.52
|
| Rate for Payer: BCBS Trust/PPO |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$31.28
|
| Rate for Payer: BCN Commercial |
$31.28
|
| Rate for Payer: BCN Commercial |
$17.14
|
| Rate for Payer: BCN Commercial |
$43.52
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Cofinity Commercial |
$35.81
|
| Rate for Payer: Cofinity Commercial |
$49.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.47
|
| Rate for Payer: Healthscope Commercial |
$36.95
|
| Rate for Payer: Healthscope Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Healthscope Whirlpool |
$38.09
|
| Rate for Payer: Healthscope Whirlpool |
$53.00
|
| Rate for Payer: Healthscope Whirlpool |
$20.87
|
| Rate for Payer: Mclaren Commercial |
$34.28
|
| Rate for Payer: Mclaren Commercial |
$18.78
|
| Rate for Payer: Mclaren Commercial |
$47.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Nomi Health Commercial |
$31.24
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: Nomi Health Commercial |
$43.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.36
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.21
|
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: Aetna Commercial |
$72.89
|
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: ASR ASR |
$78.56
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: ASR ASR |
$38.76
|
| Rate for Payer: ASR ASR |
$20.24
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCBS Trust/PPO |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$32.82
|
| Rate for Payer: BCBS Trust/PPO |
$66.51
|
| Rate for Payer: BCN Commercial |
$17.14
|
| Rate for Payer: BCN Commercial |
$66.51
|
| Rate for Payer: BCN Commercial |
$32.82
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$39.91
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Cofinity Commercial |
$76.13
|
| Rate for Payer: Cofinity Commercial |
$37.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$38.76
|
| Rate for Payer: Healthscope Commercial |
$78.56
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Healthscope Whirlpool |
$80.99
|
| Rate for Payer: Healthscope Whirlpool |
$20.87
|
| Rate for Payer: Healthscope Whirlpool |
$39.96
|
| Rate for Payer: Mclaren Commercial |
$18.78
|
| Rate for Payer: Mclaren Commercial |
$72.89
|
| Rate for Payer: Mclaren Commercial |
$35.96
|
| Rate for Payer: Mclaren Commercial |
$38.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Nomi Health Commercial |
$32.77
|
| Rate for Payer: Nomi Health Commercial |
$66.41
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.27
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$80.99
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$80.99 |
| Rate for Payer: Aetna Commercial |
$72.89
|
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: Aetna Commercial |
$38.21
|
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: Aetna Medicare |
$7.72
|
| Rate for Payer: Aetna Medicare |
$29.97
|
| Rate for Payer: Aetna Medicare |
$15.71
|
| Rate for Payer: Aetna Medicare |
$14.79
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: ASR ASR |
$38.76
|
| Rate for Payer: ASR ASR |
$20.24
|
| Rate for Payer: ASR ASR |
$78.56
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS Complete |
$8.35
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Complete |
$15.98
|
| Rate for Payer: BCBS Trust/PPO |
$32.95
|
| Rate for Payer: BCBS Trust/PPO |
$66.78
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.21
|
| Rate for Payer: BCN Commercial |
$66.78
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: BCN Commercial |
$32.95
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$76.13
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Cofinity Commercial |
$39.91
|
| Rate for Payer: Cofinity Commercial |
$37.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$78.56
|
| Rate for Payer: Healthscope Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$38.76
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$20.87
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Healthscope Whirlpool |
$80.99
|
| Rate for Payer: Healthscope Whirlpool |
$39.96
|
| Rate for Payer: Mclaren Commercial |
$38.21
|
| Rate for Payer: Mclaren Commercial |
$35.96
|
| Rate for Payer: Mclaren Commercial |
$18.78
|
| Rate for Payer: Mclaren Commercial |
$72.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.84
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Nomi Health Commercial |
$66.41
|
| Rate for Payer: Nomi Health Commercial |
$32.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.17
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$21.03
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Commercial |
$17.23
|
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Aetna Commercial |
$11.74
|
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: Aetna Commercial |
$15.31
|
| Rate for Payer: Aetna Commercial |
$13.96
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: ASR ASR |
$23.91
|
| Rate for Payer: ASR ASR |
$20.39
|
| Rate for Payer: ASR ASR |
$15.05
|
| Rate for Payer: ASR ASR |
$21.18
|
| Rate for Payer: ASR ASR |
$18.57
|
| Rate for Payer: ASR ASR |
$12.66
|
| Rate for Payer: ASR ASR |
$16.50
|
| Rate for Payer: ASR ASR |
$24.05
|
| Rate for Payer: ASR ASR |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$10.48
|
| Rate for Payer: BCBS Trust/PPO |
$20.36
|
| Rate for Payer: BCBS Trust/PPO |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$10.72
|
| Rate for Payer: BCBS Trust/PPO |
$13.97
|
| Rate for Payer: BCBS Trust/PPO |
$12.74
|
| Rate for Payer: BCBS Trust/PPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$20.24
|
| Rate for Payer: BCN Commercial |
$10.72
|
| Rate for Payer: BCN Commercial |
$12.74
|
| Rate for Payer: BCN Commercial |
$20.36
|
| Rate for Payer: BCN Commercial |
$20.24
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: BCN Commercial |
$17.27
|
| Rate for Payer: BCN Commercial |
$10.48
|
| Rate for Payer: BCN Commercial |
$15.72
|
| Rate for Payer: BCN Commercial |
$13.97
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Cofinity Commercial |
$19.76
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$23.17
|
| Rate for Payer: Cofinity Commercial |
$12.27
|
| Rate for Payer: Cofinity Commercial |
$11.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$18.57
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Healthscope Commercial |
$16.50
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Healthscope Commercial |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$23.91
|
| Rate for Payer: Healthscope Whirlpool |
$17.01
|
| Rate for Payer: Healthscope Whirlpool |
$24.79
|
| Rate for Payer: Healthscope Whirlpool |
$12.76
|
| Rate for Payer: Healthscope Whirlpool |
$19.14
|
| Rate for Payer: Healthscope Whirlpool |
$21.83
|
| Rate for Payer: Healthscope Whirlpool |
$15.52
|
| Rate for Payer: Healthscope Whirlpool |
$13.05
|
| Rate for Payer: Healthscope Whirlpool |
$24.65
|
| Rate for Payer: Healthscope Whirlpool |
$21.02
|
| Rate for Payer: Mclaren Commercial |
$15.31
|
| Rate for Payer: Mclaren Commercial |
$13.96
|
| Rate for Payer: Mclaren Commercial |
$11.48
|
| Rate for Payer: Mclaren Commercial |
$11.74
|
| Rate for Payer: Mclaren Commercial |
$17.23
|
| Rate for Payer: Mclaren Commercial |
$18.92
|
| Rate for Payer: Mclaren Commercial |
$19.65
|
| Rate for Payer: Mclaren Commercial |
$22.18
|
| Rate for Payer: Mclaren Commercial |
$22.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Nomi Health Commercial |
$20.21
|
| Rate for Payer: Nomi Health Commercial |
$17.90
|
| Rate for Payer: Nomi Health Commercial |
$12.72
|
| Rate for Payer: Nomi Health Commercial |
$10.70
|
| Rate for Payer: Nomi Health Commercial |
$10.46
|
| Rate for Payer: Nomi Health Commercial |
$13.94
|
| Rate for Payer: Nomi Health Commercial |
$17.24
|
| Rate for Payer: Nomi Health Commercial |
$20.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.69
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$12.76
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: Aetna Commercial |
$15.31
|
| Rate for Payer: Aetna Commercial |
$13.96
|
| Rate for Payer: Aetna Commercial |
$17.23
|
| Rate for Payer: Aetna Commercial |
$11.74
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Aetna Medicare |
$7.08
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: Aetna Medicare |
$8.08
|
| Rate for Payer: Aetna Medicare |
$9.12
|
| Rate for Payer: Aetna Medicare |
$4.72
|
| Rate for Payer: Aetna Medicare |
$6.29
|
| Rate for Payer: Aetna Medicare |
$5.74
|
| Rate for Payer: Aetna Medicare |
$4.83
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: ASR ASR |
$12.66
|
| Rate for Payer: ASR ASR |
$15.05
|
| Rate for Payer: ASR ASR |
$18.57
|
| Rate for Payer: ASR ASR |
$21.18
|
| Rate for Payer: ASR ASR |
$16.50
|
| Rate for Payer: ASR ASR |
$20.39
|
| Rate for Payer: ASR ASR |
$23.91
|
| Rate for Payer: ASR ASR |
$24.05
|
| Rate for Payer: ASR ASR |
$12.38
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: BCBS Complete |
$5.22
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS Complete |
$9.86
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS Trust/PPO |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$10.76
|
| Rate for Payer: BCBS Trust/PPO |
$10.52
|
| Rate for Payer: BCBS Trust/PPO |
$20.32
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$20.44
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCN Commercial |
$20.44
|
| Rate for Payer: BCN Commercial |
$17.34
|
| Rate for Payer: BCN Commercial |
$15.78
|
| Rate for Payer: BCN Commercial |
$14.02
|
| Rate for Payer: BCN Commercial |
$10.52
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: BCN Commercial |
$10.76
|
| Rate for Payer: BCN Commercial |
$20.32
|
| Rate for Payer: BCN Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$12.27
|
| Rate for Payer: Cofinity Commercial |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$11.99
|
| Rate for Payer: Cofinity Commercial |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$19.76
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Cofinity Commercial |
$23.17
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$16.50
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Healthscope Commercial |
$18.57
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$23.91
|
| Rate for Payer: Healthscope Commercial |
$21.18
|
| Rate for Payer: Healthscope Whirlpool |
$21.83
|
| Rate for Payer: Healthscope Whirlpool |
$17.01
|
| Rate for Payer: Healthscope Whirlpool |
$12.76
|
| Rate for Payer: Healthscope Whirlpool |
$19.14
|
| Rate for Payer: Healthscope Whirlpool |
$24.65
|
| Rate for Payer: Healthscope Whirlpool |
$24.79
|
| Rate for Payer: Healthscope Whirlpool |
$15.52
|
| Rate for Payer: Healthscope Whirlpool |
$13.05
|
| Rate for Payer: Healthscope Whirlpool |
$21.02
|
| Rate for Payer: Mclaren Commercial |
$18.92
|
| Rate for Payer: Mclaren Commercial |
$11.74
|
| Rate for Payer: Mclaren Commercial |
$19.65
|
| Rate for Payer: Mclaren Commercial |
$11.48
|
| Rate for Payer: Mclaren Commercial |
$15.31
|
| Rate for Payer: Mclaren Commercial |
$22.18
|
| Rate for Payer: Mclaren Commercial |
$13.96
|
| Rate for Payer: Mclaren Commercial |
$17.23
|
| Rate for Payer: Mclaren Commercial |
$22.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Nomi Health Commercial |
$12.72
|
| Rate for Payer: Nomi Health Commercial |
$10.46
|
| Rate for Payer: Nomi Health Commercial |
$20.33
|
| Rate for Payer: Nomi Health Commercial |
$20.21
|
| Rate for Payer: Nomi Health Commercial |
$17.24
|
| Rate for Payer: Nomi Health Commercial |
$13.94
|
| Rate for Payer: Nomi Health Commercial |
$17.90
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Nomi Health Commercial |
$10.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.82
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$15.05
|
|
|
Service Code
|
NDC 121090340
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: ASR ASR |
$14.60
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.41
|
| Rate for Payer: BCN Commercial |
$12.41
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$14.60
|
| Rate for Payer: Healthscope Whirlpool |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$13.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$10.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.25
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$24.03
|
|
|
Service Code
|
NDC 121495015
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna Commercial |
$21.63
|
| Rate for Payer: Aetna Medicare |
$8.89
|
| Rate for Payer: ASR ASR |
$23.31
|
| Rate for Payer: BCBS Complete |
$9.61
|
| Rate for Payer: BCBS Trust/PPO |
$19.81
|
| Rate for Payer: BCN Commercial |
$19.81
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$22.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Healthscope Whirlpool |
$24.03
|
| Rate for Payer: Mclaren Commercial |
$21.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Nomi Health Commercial |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.06
|
| Rate for Payer: Priority Health Narrow Network |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.15
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$24.03
|
|
|
Service Code
|
NDC 121495040
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna Commercial |
$21.63
|
| Rate for Payer: ASR ASR |
$23.31
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$19.73
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$22.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Healthscope Whirlpool |
$24.03
|
| Rate for Payer: Mclaren Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Nomi Health Commercial |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.15
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$15.05
|
|
|
Service Code
|
NDC 121090315
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: ASR ASR |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$12.36
|
| Rate for Payer: BCN Commercial |
$12.36
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$14.60
|
| Rate for Payer: Healthscope Whirlpool |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.25
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 9900000339
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: ASR ASR |
$4.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.84
|
| Rate for Payer: BCN Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Healthscope Whirlpool |
$4.68
|
| Rate for Payer: Mclaren Commercial |
$4.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Nomi Health Commercial |
$3.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.12
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 9900000339
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna Medicare |
$1.73
|
| Rate for Payer: ASR ASR |
$4.54
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$3.86
|
| Rate for Payer: BCN Commercial |
$3.86
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Healthscope Whirlpool |
$4.68
|
| Rate for Payer: Mclaren Commercial |
$4.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Nomi Health Commercial |
$3.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.10
|
| Rate for Payer: Priority Health Narrow Network |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.12
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$35.35
|
|
|
Service Code
|
NDC 54350049
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: ASR ASR |
$34.29
|
| Rate for Payer: BCBS Complete |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$29.15
|
| Rate for Payer: BCN Commercial |
$29.15
|
| Rate for Payer: Cash Price |
$28.28
|
| Rate for Payer: Cofinity Commercial |
$33.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.28
|
| Rate for Payer: Healthscope Commercial |
$34.29
|
| Rate for Payer: Healthscope Whirlpool |
$35.35
|
| Rate for Payer: Mclaren Commercial |
$31.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.05
|
| Rate for Payer: Nomi Health Commercial |
$28.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.97
|
| Rate for Payer: Priority Health Narrow Network |
$24.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.11
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
NDC 72888012526
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: Aetna Medicare |
$13.21
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: BCBS Trust/PPO |
$29.43
|
| Rate for Payer: BCN Commercial |
$29.43
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$34.63
|
| Rate for Payer: Healthscope Whirlpool |
$35.70
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.28
|
| Rate for Payer: Priority Health Narrow Network |
$25.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$35.35
|
|
|
Service Code
|
NDC 54350049
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: ASR ASR |
$34.29
|
| Rate for Payer: BCBS Trust/PPO |
$29.03
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: Cash Price |
$28.28
|
| Rate for Payer: Cofinity Commercial |
$33.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.28
|
| Rate for Payer: Healthscope Commercial |
$34.29
|
| Rate for Payer: Healthscope Whirlpool |
$35.35
|
| Rate for Payer: Mclaren Commercial |
$31.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.05
|
| Rate for Payer: Nomi Health Commercial |
$28.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.11
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$15.05
|
|
|
Service Code
|
NDC 121090340
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: ASR ASR |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$12.36
|
| Rate for Payer: BCN Commercial |
$12.36
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$14.60
|
| Rate for Payer: Healthscope Whirlpool |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.25
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 17856077502
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: ASR ASR |
$11.64
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.89
|
| Rate for Payer: BCN Commercial |
$9.89
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Healthscope Whirlpool |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$10.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.51
|
| Rate for Payer: Priority Health Narrow Network |
$8.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.56
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$15.05
|
|
|
Service Code
|
NDC 121090315
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: ASR ASR |
$14.60
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.41
|
| Rate for Payer: BCN Commercial |
$12.41
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$14.60
|
| Rate for Payer: Healthscope Whirlpool |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$13.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$10.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.25
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$24.03
|
|
|
Service Code
|
NDC 121495015
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna Commercial |
$21.63
|
| Rate for Payer: ASR ASR |
$23.31
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$19.73
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$22.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Healthscope Whirlpool |
$24.03
|
| Rate for Payer: Mclaren Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Nomi Health Commercial |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.15
|
|
